Uveitis in juvenile idiopathic arthritis

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A major recent advance in the management of severe juvenile idiopathic arthritis (JIA) has been the availability of bioengineered blocking agents directed against tumor necrosis factor α (TNF): infliximab and etanercept. Although experience with these agents in children is limited thus far, they clearly appear to be efficacious.

Although uveitis is a recognized accompaniment of some forms of JIA, concern has been raised by recent case reports of this developing during the course of therapy with TNF blockers. In the current issue of The Journal, this question is addressed based upon study of a cohort of over 1000 children with JIA, followed at the Hospital for Sick Children in Toronto. Of these, 70 received therapy with one of the TNF blocking agents. Meticulous follow up was available for these children. The take-home message of this study is that the incidence of new-onset uveitis in this population was apparently not affected by the use of these drugs.

As would be the case for any potent new agents, continued vigilance of these children is critical. At this point, however, it would appear that concern about inducing or exacerbating uveitis is assuaged.